MRI brain shows bilateral symmetric T2/FLAIR hyperintensities in the medial thalami and periaqueductal grey matter in a malnourished chronic alcoholic admitted for confusion and ophthalmoplegia. The diagnosis and initial treatment are:
- A Wernicke encephalopathy — treat with intravenous thiamine (Vitamin B1) ✓
- B Central pontine myelinolysis — treat with slow sodium correction
- C Wilson's disease — treat with d-penicillamine
- D Leigh syndrome — supportive treatment
Correct answer: A. Wernicke encephalopathy — treat with intravenous thiamine (Vitamin B1)
Explanation
Wernicke encephalopathy (thiamine/B1 deficiency) classically shows bilateral T2/FLAIR hyperintensities in the medial thalami, mammillary bodies, and periaqueductal grey matter on MRI. The clinical triad is confusion, ophthalmoplegia, and ataxia. Immediate IV thiamine is mandatory before glucose administration to prevent progression to Korsakoff psychosis. Central pontine myelinolysis affects the pons with rapid sodium correction. Wilson's shows basal ganglia/dentate nuclei changes.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.